Your Brother's Heart Problems May Be Yours, Too

Cardiologists have long recognized that premature coronary artery disease in a first-degree relative (parent, sibling, or child) puts their patients at risk. "Premature" is usually defined as coronary disease before the age of 50 in a male and before age 60 in a female.

Family studies of someone's risk of coronary artery disease have focused on whether and when one or both parents developed the condition. Now a recent publication from the Framingham Offspring Study has corroborated earlier reports from Johns Hopkins, which have documented the importance of early coronary disease in one's brothers and sisters.

In fact, the Framingham study found that premature coronary disease in a sibling represented a greater risk for coronary disease than premature disease in parents. Premature disease in a sibling appeared to impart a significantly higher risk of cardiovascular events only for men and women under the age of 60.

The greater risk associated with sibling coronary disease suggests that not only genetic factors, but also shared early environmental exposures, play important roles in the development of the disorder.

These findings have several practical implications to help you lower your risk:
You should learn as much as you can about your family health history, including that of any brothers or sisters. In my experience, many patients have no idea whether their siblings have had heart attacks, bypass surgery, angioplasty, or high cholesterol levels. I have always asked my patients to obtain such information.

Doctors must take more complete family histories from their patients and pay more attention to coronary disease in siblings.

Doctors often use the Framingham Risk Equation to estimate the likelihood that their patients will develop coronary artery disease. This risk assessment tool, however, fails to include family history of premature coronary disease.

These latest findings should encourage development of a new risk equation that includes the impact of premature coronary disease in both parents and siblings on one's future cardiovascular health.